Massachusetts Sues UnitedHealthcare for Medicaid Fraud (Correct)

UnitedHealthcare is facing accusations that it defrauded at least $100 million from Massachusetts’ Medicaid program, according to a lawsuit filed by the state on Friday.

The lawsuit accuses UnitedHealthcare of falsely manipulating information on members of a voluntary senior care plan developed with MassHealth, the state’s Medicaid program, in order to claw higher payments from the state. To do so, the lawsuit says UnitedHealthcare ranked members’ health conditions in ways that guaranteed more money from MassHealth, such as claiming they had diagnoses like anxiety, as well as submitted assessments stating that members needed unnecessary regular skilled nursing services.

“The state’s managed care plans need to act in good faith on behalf of their members and the financial resources of our state’s Medicaid program. Our investigation found that United Healthcare knowingly violated these obligations by manipulating health assessments to increase its profits,” Massachusetts Attorney General Andrea Joy Campbell said in a statement.

Friday’s legal action comes at a time of heightened focus on Medicaid fraud across the states.

The Trump administration has increasingly pressured states for allegedly doing too little to curb fraud within their borders, including threatening to withhold Medicaid funds if they don’t comply with anti-fraud statutes.

Massachusetts in its lawsuit claims that “United relentlessly pursued a growth-at-all-costs strategy that failed to allocate resources to ensure that it accurately reported members’ conditions to MassHealth.”

The state says the company “chronically understaffed the nurses who were responsible for assessing members” and “created an incentive structure in which United’s overworked nurses would not have to complete as many member assessments if they represented that the members had more serious health conditions, even if those members did not.”

“United also built a team to conduct quality control of member assessments before submitting those assessments to MassHealth, then abandoned that quality control process for half of member assessments when it developed a backlog that resulted in United making less money,” the complaint said.

“The Massachusetts Attorney General’s complaint is meritless and doesn’t accurately describe our Senior Care Options program, which helps seniors with complex care meet their individual health needs,” UnitedHealthcare said in an emailed statement. “The Attorney General is simply wrong that Massachusetts seniors with complex care needs should not be receiving the support and services UnitedHealthcare is helping to provide.”

The case is Massachusetts v. UnitedHealthcare Insurance Company, Mass. Super. Ct., complaint filed 5/29/26